In our part of the world, women typically experience the onset of menopause between the ages of 46 and 50. For Caucasian women, it’s often even later – say between 50 and 54 years. In some cases though, bodies are a little reluctant to stick to the schedule. Menopause can be a physical and emotional [...]

The Sundaytimes Sri Lanka

A subjective rite of passage

Knowledge of symptoms and treatment of Premature Onset Menopause can help women through the physical and emotional challenges
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In our part of the world, women typically experience the onset of menopause between the ages of 46 and 50. For Caucasian women, it’s often even later – say between 50 and 54 years. In some cases though, bodies are a little reluctant to stick to the schedule. Menopause can be a physical and emotional challenge to weather even when you’re braced for it, but what happens when you’re not? This week, Dr. Nalinda Rodrigo, Consultant Obstetrician and Gynaecologist discusses Premature Onset Menopause, explaining diagnosis, symptoms and treatment options.

If you’re experiencing the symptoms of menopause before the age of 40, you could be diagnosed with this condition. In essence it means that your ovaries have ceased to function. A woman’s reproductive glands, the ovaries are located in the pelvis, stationed like bodyguards on either side of the uterus. They are small – the size of an almond – yet they play a critical role in body functions, producing not only eggs or ova but the female hormone oestrogen. Oestrogen is a key player in a woman’s sexual and reproductive development.

When women begin menopause is determined by many elements. For instance, nutritional history and genetic inheritance play a role. As our societies become wealthier and we eat better, menopause comes later, held at bay by improved nutrition. (Of course, this means that women’s reproductive years are extended as a natural consequence.) However, when your mother and her mother before her experienced menopause is likely to offer a hint as to when you can expect to do the same.

Dr. Rodrigo explains that there is also a curious correlation between when women report menarche (their first menstrual cycle) and when menopause sets in. Research has shown that girls who begin menstruating early – not between the age of 10 – 12 as is normal but around age 9 instead – will also begin menopause later. They may be grateful for the reprieve, because menopause isn’t exactly a stroll in the park.

Among the most common symptoms are hot flashes, heart palpitations and night sweats that quite naturally lead to disrupted sleeping patterns. Your period changes, and may be irregular or of an unpredictable intensity. Dry skin and or hair loss are common, while some women also complain of vaginal dryness, abnormal bleeding during intercourse and mood swings.Reduced libido, urinary tract infections and incontinence round up a depressing list of symptoms.
However, the withdrawal of these hormones also marks the end of the protection oestrogen has offered women all their lives – now like the men around them they become vulnerable to heart disease and strokes. Osteoporosis can worsen dramatically as oestrogen also plays a role in bone formation. In its absence women become more vulnerable to issues of poor bone density and fractures associated with osteoporosis. The integrity of your organs is threatened as your vaginal walls thin and your uterus lowers, says Dr. Rodrigo.

It takes 12 months of absent periods for a doctor to officially diagnose menopause. This makes it clear that menopause isn’t something that happens overnight. In fact, perimenopause, which is often identified thanks to irregularities in the menstrual cycle combined with the symptoms above, has been known to take a decade before a last period marks one’s entry into menopause. What is behind this dramatic transformation in your body’s hormonal make-up?

For starters, one of the known causes of early onset menopause is polycystic ovarian syndrome says Dr. Rodrigo, which is also liked to a higher risk of ovarian cancer. A handful of medical and surgical conditions can also influence the timing of menopause. Removal of ovaries, known as an oophorectomy is one way to bring on its immediate onset. (Women who have hysterectomies, with the surgical removal of the uterus unaccompanied by the removal of the ovaries, can still expect their ovaries to produce oestrogen.) Other causes are chemotherapy and radiation used as therapies in cancer treatment. Other drugs may also be to blame, says Dr. Rodrigo, pinpointing medication prescribed to treat psychotic conditions like schizophrenia and severe bipolar disorders.

Like the age of onset, how long these symptoms last varies from woman to woman, says Dr. Rodrigo. For some it can be a significant period of time – spanning years instead of months.He adds that when it comes to premature menopause, women will be forced to spend a greater percentage of their lives without the umbrella of their protective hormones to stand under, leaving them at greater risk for menopause-related health problems.

It’s clear that the physical challenges can be quite stressful, but women may also struggle with the implications of menopause. For some, the end of their fertile years is also intertwined with a sense of diminished femininity. This psychological strain may be compounded because the aging process appears to speed up as women look visibly older with more wrinkles and weight gain. External changes may play their part as women deal with responsibilities outside the home such as work stress, retirement or elderly parents.

Though menopause may seem overwhelming, associated as it is with so many depressing symptoms, it is important to remember that it is a rite of passage for most women. It is also highly subjective. Not every woman will experience every symptom or even experience it with the same intensity. Treatment may focus on individual conditions such as osteoporosis. Here, early detection can make a huge difference, substantially improving the chances that treatment will be effective. Lifestyle changes, such as quitting smoking, curtailing alcohol intake, regular exercise and a nutritious diet will always help to offset some of the risks.

Sometimes doctors will consider using Hormone Replacement Therapy or HRT to postpone menopause says Dr. Rodrigo, who however cautions that HRT has its own related problems. Hormone therapies have been linked to an increased risk of heart attacks, strokes, breast cancer and endometrial cancer. Whether to take this or not must be decided on a case by case basis, with a doctor alerting patients to all the risks and benefits hormone therapy brings. Women can find ways to ease their passage through menopause by taking an active hand in their treatment. Simply understanding what is happening to your body can help you respond better to symptoms, while the support of family and close friends will see you through.

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